Provider Demographics
NPI:1235219577
Name:UDDEN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:UDDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2348
Mailing Address - Country:US
Mailing Address - Phone:713-798-2500
Mailing Address - Fax:713-798-2505
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-2500
Practice Address - Fax:713-798-2505
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8986207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131355304Medicaid
E38860Medicare UPIN
TX131355304Medicaid
TX80X605Medicare PIN
TX110169058Medicare PIN
TXTXB125005Medicare PIN